This Week in Managed Care: June 28, 2019

This week, the top managed care news included President Trump issuing an executive order for more healthcare transparency; provisional data indicating that overdose deaths may be falling; the Supreme Court agreeing to hear insurers' Affordable Care Act lawsuit.

President Trump orders more transparency in hospital rates, the number of overdose deaths appears to be falling for the first time in decades, and the Supreme Court will hear a case about insurers not being paid for taking on Affordable Care Act (ACA) risk.

Welcome to This Week in Managed Care. I’m Samantha DiGrande.

Trump Issues Executive Order on Disclosing Negotiated Rates

Hospitals and insurers will have to lift the veil on their rate negotiating process under an executive order that President Trump signed Monday. The order sets in motion a rule-making process that will require payers to give patients estimates of their out-of-pocket costs before they receive care, and make hospitals disclose prices in a patient-friendly format.

Said Trump: “With today’s historic action, we are fundamentally changing the nature of the healthcare marketplace. This is bigger than anything we’ve done in this particular realm. We will empower patients with the information they need to search for the lowest cost and the highest quality care.”

While federal officials praised the order, the insurance industry said it might not cut healthcare costs. Said Matt Eyles, president and chief executive officer of America’s Health Insurance Plans, “Requiring price disclosure for thousands of hospital items, services, and procedures perpetuates the old days of the American healthcare system paying for volume over value. We know that is a formula for higher costs and worse care for everyone. We should be accelerating our efforts to pay for healthcare based on value and quality.”

The order also calls for consolidating quality car measures and promotes the use of health savings accounts.

After years of offering grim statistics about the opioid epidemic, the CDC offered news on Wednesday it had not shared in nearly 2 decades: The number of overdose deaths may be declining. While the final figure is still being tallied, provisional data show the number of deaths for the 12-month period ending in November 2018 is below 70,000, compared with 72,287 for November 2017.

If this trend continues into December 2018, it would be the first time annual drug overdose death rates have declined since the 1990s.

In the 3 decades since, overdoses have claimed 870,000 lives in the United States. States have taken a multipronged approach to combatting the epidemic, and in April, FDA approved the first generic nasal spray version of naloxone, which can reverse an overdose. Just this month, New Jersey offered the drug for free at pharmacies across the state without a prescription.

The US Supreme Court will hear a case involving the ACA—but this one involves insurers, not consumers. At issue are payments known as risk corridors, which were called for under the ACA to protect insurers who agreed to offer coverage in the marketplace in its early years, when many who had never been insured were buying plans for the first time in years, if ever.

Risk corridors helped protect insurers from unexpected losses to ensure market stability. But when Republicans gained control of Congress after 2010, they refused to fully fund them. The case that will reach the Supreme Court this fall claims insurers lost $12 billion. However, many companies have already gone bankrupt.

For many who survive cancer, the long-term effects last after treatment, including chronic pain. A study published this week in JAMA Oncology found that 5.4 million people, or about 1 in 3 cancer survivors, lives with chronic pain. About half of this group, or 2.5 million, suffers high-impact chronic pain, a rate double that of the general population.

The study also found:

Rates of chronic pain were higher among those with less than a high school education

Rates were higher for those with low incomes or no paid employment

Rates were higher among those with public insurance

The researchers reported: “Because socioeconomic status and employment are associated with insurance coverage and access to care in the United States, the patterns of chronic pain that we observed in cancer survivors may be explained by barriers to cancer care and pain management as well as by the type and extent of cancer treatment received.”

Evidence-Based Oncology™ Focuses on Ways to Pay for Cancer Care

Finally, the current issue of Evidence-Based Oncology™ (EBO) looks at new ways to pay for cancer care, including models that pay for expensive, one-time therapies over time.

The issue features the following:

An interview with an initiative at MIT, called NEWDIGS, that brings stakeholders together to develop new financing solutions

An article by EBO associate editor Kashyap Patel, MD, and his colleagues on using reinsurance to take on 2-sided risk in the Oncology Care Model